Australian carybdeid jellyfish causing "Irukandji syndrome".

The Australian carybdeid jellyfish associated with Irukandji syndrome is Carukia barnesi, (Barnes' jellyfish). Other Australian carybdeid jellyfish that may be associated with the syndrome include Carukia shinju, Carybdea xaymacana, Malo maxima, Malo kingi, Alatina mordens, Gerongia rifkinae, and Morbakka fenneri ("Morbakka"). These small jellyfish are difficult to capture and identify. They are located offshore of the coasts of Australian states including Queensland, The Northern Territory, Western Australia and South Australia. The syndromic illness, resulting from a characteristic relatively minor sting, develops after about 30 minutes and consists of severe muscle pains especially of the lower back, muscle cramps, vomiting, sweating, agitation, vasoconstriction, prostration, hypertension and in cases of severe envenomation, acute heart failure. The mechanisms of actions of their toxins are obscure but they appear to include modulation of neuronal sodium channels leading to massive release of endogenous catecholamines (C. barnesi, A. mordens and M. maxima) and thereby to possible stress-induced cardiomyopathy. In addition, pore formation may occur in myocardial cellular membranes (C. xaymacana). In human cases of severe envenomation, systemic hypertension and myocardial dysfunction are associated with membrane leakage of troponin. Clinical management includes parenteral analgesia, antihypertensive therapy, oxygen and mechanical ventilation. No effective first-aid is known. Large knowledge gaps exist in biology of the jellyfish, their distribution, their toxins and mode of actions and in treatment of the Irukandji syndrome.

Snakebite mortality at Port Moresby General Hospital, Papua New Guinea, 1992-2001.

OBJECTIVE: Fatal snakebites at Port Moresby General Hospital (PMGH), Papua New Guinea (PNG), were examined to identify interventions that may improve patient survival. DESIGN: Retrospective case series. SUBJECTS AND SETTING: Inpatients at PMGH who presented with snakebite, had evidence of envenomation, and died as inpatients between 1 January 1992 and 31 December 2001. OUTCOME MEASURES: Number and cause of fatalities; ventilation bed-days; antivenom timing, dose and price. RESULTS: 87 deaths occurred among 722 snakebite admissions to the intensive care unit (ICU). Of these 722 patients, 82.5% were ventilated, representing 45% of all ventilated ICU patients and 60% (3430/5717) of all ICU ventilator bed-days. The median duration of ventilation in fatal snakebite cases was significantly less than in non-fatal cases for children (3.0 v. 4.5 days) and adults (3.0 v. 5.0 days). The case-fatality rate for children (14.6%) was significantly greater than that for adults (8.2%). Sixty fatalities were examined in detail: 75% received blood products; 53% received antivenom (mostly a single ampoule of polyvalent), but only 5% received antivenom < or = 4 hours post-bite. Major causes of death included respiratory complications (50%), probable intracerebral haemorrhage (17%), and renal failure (10%). Antivenom unit costs increased significantly over the decade; in 2000 an ampoule of polyvalent antivenom was 40-fold more expensive in PNG than in Australia on a gross domestic product (A dollars) per capita basis. CONCLUSIONS: Management of severe snakebite is a major challenge for PMGH. Improved antivenom procurement and use policies (including increased use of appropriate monovalent antivenoms), combined with targeted snakebite education interventions (community- and hospital-based), are key interventions to reduce the ongoing toll from snakebite.

Phospholipase A2 in cnidaria.

Phospholipase A2 (PLA2) is an enzyme present in snake and other venoms and body fluids. We measured PLA2 catalytic activity in tissue homogenates of 22 species representing the classes Anthozoa, Hydrozoa, Scyphozoa and Cubozoa of the phylum Cnidaria. High PLA2 levels were found in the hydrozoan fire coral Millepora sp. (median 735 U/g protein) and the stony coral Pocillopora damicornis (693 U/g) that cause skin irritation upon contact. High levels of PLA2 activity were also found in the acontia of the sea anemone Adamsia carciniopados (293 U/g). Acontia are long threads containing nematocysts and are used in defense and aggression by the animal. Tentacles of scyphozoan and cubozoan species had high PLA2 activity levels: those of the multitentacled box jellyfish Chironex fleckeri contained 184 U/g PLA2 activity. The functions of cnidarian PLA2 may include roles in the capture and digestion of prey and defense of the animal. The current observations support the idea that cnidarian PLA2 may participate in the sting site irritation and systemic envenomation syndrome resulting from contact with cnidarians.

An analysis of marine animal injuries presenting to emergency departments in Victoria, Australia.

OBJECTIVE: To describe the epidemiology of marine animal injury in Victoria, Australia, in order to identify risk factors and recommend prevention strategies. METHODS: Retrospective, descriptive study of patients with marine animal injuries who presented to Victorian emergency departments between October 1995 and June 2000. Data were obtained from the Victorian Emergency Minimum Dataset. The main outcome measures were the marine animal involved; the nature, time, and place of injury; and subject demographics and activity. RESULTS: Two hundred five injuries were identified, and males predominated (71.7%, P < .01). Injuries were most frequent during summer and when jellyfish were most prevalent. Various fish species, stingrays, jellyfish, and sharks were incriminated in 83 (40.5%), 46 (22.4%), 42 (20.5%), and 5 (2.4%) injuries, respectively. Most (65.9%) injuries occurred during leisure or sport, and 72 (35.1%) occurred in a place of recreation. Spikes, spines, and barbs caused 82 (40.0%) injuries, and stings caused 54 (26.3%) injuries. Bites were uncommon. Most injuries were to the limbs, with the hands or feet injured in 127 (62.0%) patients. Forty (19.5%) injuries were associated with a retained foreign body. Only 17 (8.3%) patients required admission to the hospital. CONCLUSIONS: Marine animal injury is seasonal but rarely serious. Vigilance is required when handling fish, and protective gloves, footwear, and clothing are recommended where appropriate. Clinicians should consider retained foreign bodies in penetrating injuries. Warnings are recommended when jellyfish are most prevalent.